Assessment and correction of the geriatric status of patients with metastatic colorectal cancer during the first-line systemic therapy

Humanity is rapidly aging, about 50% of all human malignancies develop in people over 65 years old. Cancer and antineoplastic therapy are potential pathophysiological stressors that worsen the course or intensify the development of previously compensated comorbidities and geriatric syndromes. At present, the role of assessment and correction of geriatric syndromes (CGS) for the purpose of effective first-line drug therapy in patients with metastatic CRC in the elderly and senile age, based on the use of a comprehensive geriatric assessment, has not been evaluated.

Aim. Improving the efficiency of the first-line systemic antineoplastic treatment of patients with metastatic colorectal cancer in the elderly and senile age against the background of assessment and correction of the gerontological profile.

Materials and methods. The study included data on 177 patients with metastatic colorectal cancer T1-4N1-2M1 (stage IV) who underwent first-line systemic therapy based on the FOLFOX-6 scheme at the Petrov National Medical Research Centre of Oncology from 2015 to 2021. The prospective group included 59 middle-aged and elderly patients who underwent assessment and CGS on the background of first-line systemic therapy. For analyzing the impact of assessment and CGS on the efficiency (objective response, disease control, event-free survival – EFS) and the toxicity of systemic treatment, a retrospective review of the medical histories of 118 middle-aged and elderly patients who did not undergo assessment and CGS was performed.

Results. Assessment and CGS allows to improve the results of patients with metastatic colorectal cancer, independently of age and treatment regimen: the toxicity is lower in the CGS group, neutropenia grade 3 was absent in the group with CGS, without CGS 10.7 and 14.8% for elderly and middle-aged, respectively; clinically significant response is also better in the group with CGS – 87.8%; without CGS – 69% (p<0.05); the median EFS is 9.9 [8.84–11.08] months in the group with CGS, and 7.2 [4.15–10.24] months without CGS (p=0.02).

Conclusion. In order to improve the efficiency of treatment of patients with metastatic colorectal cancer in the clinical practice of oncologists, it is advisable to conduct a comprehensive geriatric assessment and correction of geriatric syndromes.